Diabetes and Surgery

Here’s a question I’ve always wondered about: what are people with diabetes supposed to do if they have to have surgery? Not only does the trauma of having someone cut into your body seem like it would send your blood sugar sky high, but what are you actually supposed to do in the operating room? How should you prepare? What precautions should you take? And what adjustments do you need to make during your recovery?

I recently had the chance to find out all this and more when I had arthroscopic surgery on my right shoulder for a SLAP tear. In non-medical terms, I ripped a piece of cartilage off of part of the bone of my shoulder joint, and I needed to have a surgeon go in and reattach it. It’s an injury really common among professional baseball pitchers. I, on the other hand, did mine while stretching.

Today marks three weeks from the date of surgery (and my first day out of my sling!) and I thought I’d take advantage of my newly limber right arm to make a list of suggestions and observations that others might find useful. So here goes:

1. Several weeks before your surgery, ask your surgeon if s/he will need you to do any additional medical tests beforehand. For example, I had to get an EKG and a blood panel done two weeks before my surgery and have the results faxed in to my surgeon’s office in order to get clearance for the surgery to be done. If they hadn’t received these test results, the surgery would have been cancelled. Which leads me to my next suggestion:

2. Do not forget to get these tests done. Not that I almost did, leading to the surgeon’s assistant leaving me desperate voicemails as I celebrated my best friend’s wedding in California, far away from my insurance company’s approved provider network. No, I’d never do that.

3. If your surgeon’s office does not automatically do this, request that you be scheduled as the first surgery of the day. Remember: you’ll be fasting starting from midnight the night before, and can’t have anything at all to eat or drink (not even water, gum, or glucose tablets). You don’t want to have to cancel your surgery because it’s 1 pm and your blood sugar has gone low (or, for that matter, crazy high).

4. Make an appointment with your diabetes specialist/endocrinologist several weeks before the surgery and ask them to write a letter to the surgical team informing them that you have Type 1 or Type 2 diabetes, and telling them what to do about it. In my case, my endocrinologist gave them all my basal settings for my pump, asked them to check my blood sugar once an hour during surgery and adjust levels with a dextrose drip if necessary, and said she’d given me permission to wear my pump during surgery (definitely ask about that — if it’s a longer procedure, they may not want you to).

5. During that same appointment with your diabetes specialist, ask your doctor what you yourself should do before surgery. My doctor suggested that, due to the concerns about my blood sugar going low because of the fasting, I run my sugar conservatively high the night/morning before. Nothing crazy — she didn’t want me to go in super high, but she wanted to be sure I didn’t run the risk of plummeting just as they wheeled me in.

6. If you wear a pump, be sure to ask your diabetes doctor what to do with your basal rates the night before/day of the surgery. Mine suggested running them at a temporary basal rate of 80% normal, just to be safe — but be sure to ask your provider for specific instructions.

I found all this worked quite well. I went into surgery at around 135 mg/dl and came out hovering in the 120s. Much to my surprise, my blood sugar also did not spike crazily later that day as my body realized what I’d had done to it. Which leads me to several tips for recovery:

1. When your body is in pain, it releases stress hormones. Stress hormones make your blood sugars go high. Therefore, in my opinion at least, pain management is an important component of post-surgery blood glucose control. I opted to get a nerve block for my arm, which essentially means they deaden the whole thing from the shoulder to your fingers — making it completely pain-free for about 12 hours. That meant that my body had a couple hours of blissful ignorance between when I came out of anesthesia and when the block wore off. My blood sugars during that time were fine. And, actually, not all that bad afterwards. The shoulder, on the other hand, hurt like a bitch.

2. Which brings me to the pain meds: Ask your doctor if any of the pain/post-surgery meds will interact with/interfere with your diabetes treatment in any way. For example, I use the Dexcom Seven Plus Continuous Glucose Monitoring System, and its sensor gets screwed up by acetaminophen, the active ingredient in Tylenol. Percoset also contains acetaminophen (it’s a combo of acetaminophen and oxycodone) — so instead of Percoset, I took a doctor-approved combination of oxycodone and ibuprofen, which does not mess up my CGM.

3. Monitor your blood glucose levels carefully in the days after surgery. Remember, you’re not going to be walking around a lot, let alone doing your normal exercise routine, and between that and the pain, your blood sugars may run higher than normal. On the flip side, you may not have much of an appetite (I had basically none at all) so your normal basal rates or even boluses may be too high. I ended up doing a bit of a combo — I bumped up the basal rate a bit, but bolused conservatively. It worked pretty well.

I have to say that, despite all my apprehensions, the diabetes side of this experience has gone surprisingly well. Granted, I’m

The day after.

going a bit nuts from not being able to exercise as I normally do (and my right arm has noticeably atrophied just from three weeks in a sling). But I’m well on the road to recovery, and diabetes — both thankfully and surprisingly — has not been as big a burden as I’d previously feared.

Any other suggestions for how to cope with diabetes during and after surgery? Please leave your thoughts below!

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Marla

Hi I’m about to have surgery for a torn rotator cuff (Type 1, 30 years). I have a CGM, do you think I can wear it during surgery? I will ask all these questions when I have the opportunity, but you said you have one, but didn’t mention if you could wear it during the procedure.

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1 year ago

Angela Delgado

good Afternoon

I currently have a meniscus tear in my right knee. I am presently going to some physical therapy to keep my knee mobile. However, I also have diabetes type 2 and I am concerned regarding the Arthroscopic procedure my orthopedic has advised. I am not in too much pain, however, when there is pain, I take a pain med. I may need to make this decision soon regarding the surgery. I have not decided to go for the Athroscopic procedure as yet. What advice can I receive regarding this decision that is best. Thank you.

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6 years ago

Jackie Clark

Hi,

I have a question for you regarding your blog. Please contact me when you get a chance.

Thanks!

Jackie

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7 years ago

Randy Anderson

Catherine, Your specific surgery points out another issue of importance to those with diabetes. People with diabetes are more prone to tendon/ligament tears, are more susceptible to muscle adhesions leading to restricted range of motion, and are more likely to need arthroscopic surgery to correct these problems. One of the causal factors may be the advanced glycated endproducts (AGEs) likely resulting from hyperglycemia that may interfere with muscle and tendon flexibility. DAILY stretching and GRADUAL warmups may be the best strategy for maintaining flexibility and preventing such injuries. As a veteran of two shoulder arthroscopy surgeries, I can’t overemphasize the… Read more »

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7 years ago

Elaine

That’s how I have handled my past surgeries and it’s worked great. I would like to know more about how you handled being one armed. I am facing a similar surgery in a few weeks and am worried about how to get dressed, how to sleep and how to change my pump sites with one arm. You make it sound easy. I hope it is.

I’m so glad your surgery went well and that diabetes was okay! I agree, this is really informative and helpful. I had a c-section in 2009. My first blood sugar check after it was 79. I remember feeling really relieved because I’d been expecting it to be very high. I hope you’re back to your normal workout routine very soon.

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7 years ago

Stoyan

Wow, this is certainly a very informative and helpful piece. I have not had to go through surgery since being diagnosed with type 1 over 5 years ago, and have not really thought about what it would entail. It does sound like you need to be very well prepared and make sure all the doctors know your condition, what you are taking/devices you are using, how you might need to change your regime, and so on. Goes to show you how many different areas of your life diabetes affects and where it continues to prop up. Thank you for sharing… Read more »

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